Providing bad news

Communication and Health Literacy

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SPIKES and other tips

There are six distinct steps to communicating bad news well.1

Step

Process

1

Set up the situation as well as you can. Plan the conversation, think about who should be there, avoid interruptions & have tissues. Sit down reasonably close to the person and make eye contact.

2

Find out the person’s perception or understanding. What do they know? What are their expectations or goals? Correct any misunderstandings they may have.

3

Invitation: Ask the person how much information they want.

4

Give knowledge and information: Use plain language. Avoid jargon. Warn the person that bad news is coming. For example: “I have some serious news to tell you.” Provide context. For example: “You know you had a ____ test last week to see ____? Well, what we found is that ___”

5

Empathise: Respond to the person’s feelings. Give them time. Allow silence.  Resist telling someone how they should feel. Acknowledge shock and any other emotion. You could say, ‘this must be upsetting’. Empathic reflection tells a person you are listening to their words and body language.  Ask what questions or concerns they have.

6

Summarise and develop strategies: Summarise the important information and plan the next step. Be as concrete as possible. Check they understand what you have talked about. Write down the key points for the person to look at later or share with others

Spikes

  • Set up
  • Perception
  • Invitation
  • Knowledge
  • Empathise
  • Summarise

Other tips for giving bad news1

  • Ensure privacy.
  • Turn mobile phones off.
  • Ask the person about their concerns. This can help them feel heard and help you plan the required support. For example: “What concerns you most about this news?” Remember to use open-ended questions.
  • If a person asks difficult questions like “How long do I have to live?” answer honestly, and try to get a sense of the person’s main concerns. Tailor your response and support.
  • Be aware of your own emotions and feelings such as sadness, guilt, disappointment, fear, anger or shame. Discuss your emotions with colleagues before you meet with a person, to reduce your emotions getting in the way.
  • Listen. Really listen. Show you are listening by reflecting on what the person says, for example: “It sounds like . . .”
  • Show empathy and identify the person’s emotions. For example: “I can see you’re devastated by this news.”
  • Be affirming. Give positive comments about strengths and effort. For example: “You’ve been so strong.”
  • Be willing to explore hopes and concerns.
  • Offer another conversation at a later time with the person and others they’d like there.

Common barriers to good communication when giving bad news1

Feeling you are responsible for maintaining the person’s hope.

  • Ignoring your own feelings.
  • Making assumptions about what the person knows and doesn’t know.
  • Assuming you know what the person wants, for eg that a cure is the goal.
  • Talking too much.

1. Vitaltalk, Disclose Serious News, viewed 6th September, 2018, http://vitaltalk.org/resources/

Updated December 2018